Lecture 1 Flashcards
These increase the incidence of medical emergencies in dental offices
• Geriatric population seeking dental care
• Number of patients taking medications
• Number of medications taken per patient
• Length of dental appts
• Administrations of drugs by dentists
Amount of emergencies that occur in dental offices in 10 years
In 10 years, on average there are about 7.5 emergencies that occur in a dental office. 1/3 of them are life-threatening so prevention is key.
Most common med emergencies experienced at the dental office
- Syncope
- Mild allergic reaction
- Angina pectoris
- Orthostatic hypotension
- Seizures
- Asthmatic attack (bronchospasm)
- Hyperventilation
- Epinephrine reaction
- Hypoglycemia
- Cardiac arrest
- Anaphylactic reaction
- Myocardial infarction
Occurrence of systemic complications
• Before tx:
◦ 1.5%
• During and after local anesthetic
◦ 54.9%
• During tx:
◦ 22.0%
• After tx:
◦ 15.2%
• After leaving dental office:
◦ 5.5%
Keys to prevention of medical emergencies
Medical history and vital signs
Components of medical history
• Medical history: must be complete and accurate
◦ Chief complaint
◦ Medication
◦ Medical conditions past and present
◦ Allergies
◦ Review of system?
◦ Hx of surgeries
◦ Social hx
Components of vital signs
BP
Pulse
Temp
Respiration
Be alert as a clinician, if a patient notes a medical condition, know how that condition could turn into a med emergency. Give examples
‣ Patient has
• Heart conditions: be alert to MI, congestive heart failure or CVA
• Asthma: be alert to possible asthma attack
• Has history of CVA (stroke) frequent headaches and dizziness: be alert to a possible CVA
• Epilepsy: be alert to seizure
• Thyroid problems: be alert to myxedema coma or thyroid storm
• Diabetes: hypoglycemia and diabetic coma
• Corticosteroid use: adrenal insufficiency
• Allergies: allergic reaction
• Bleeding disorders: bruising, hemorrhages, hemophilia
What is blood pressure?
The force exerting by the blood against the vessel walls
Systolic blood pressure
The pressure in the vessels during ventricular contraction
Diastolic blood pressure
The pressure in the vessels during ventricular relaxation
Blood pressure categories
Factors affecting blood pressure
‣ Things that affect BP
• Blood viscousity
• Blood volume
• Vessel resistance
• Age: elders and arteroschlerosis caused higher BP
• Gender: higher in men and post menopausal women
• Stimulants: coffee and nicotine (vasoconstrictors)
• Exercise: consistent exercise lowers BP and BP higher immediately after exercise
What is pulse?
Speed and force of patient’s heartbeat
Common areas taken for pulse
radial, brachial, femoral, carotid
• Use radial for baseline reading in case of emergency
Abnormal pulse categories
‣ Tachycardia (greater than 100 bpm)
• Body is trying to increase oxygen to tissues
• Occurs due to
◦ Fever
◦ Exercise
◦ Nervous excitement
◦ Medications
◦ Stimulant drugs
◦ Disease states (CHF, hemorrhage and shock)
‣ bradycardia (less than 60 bpm)
• Occurs due to
◦ Iightheadedness
◦ Dizziness
◦ Chest pain
◦ Syncope
◦ Circulatory collapse
• Treat with atropine
‣ arrhythmia (irregular)
Normal pulse
What is respiration?
The process by which oxygen and carbon dioxide are exchanged in the body; involuntary
Abnormal respiration
‣ Tachypnea: greater than 20
• Hyperventilation
‣ Bradypnea: less than 12
• Syncope
‣ Dyspnea: difficulty breathing
• Usually associated with heart or lung disease
‣ Apnea: absence of breaths
‣ Orthopnea: shortness of breath while laying back (recumbent)
Normal respiration
‣ Things that affect/influence respiration
• Age: age increases-> lung capacity increases= lower RR; aging=lung less elastic RR increases
• Medications: Narcs decrease RR, sympathomimetics dilate briochioles and improve RR
• Stress or exercise: increases strength and depth of breathing
• Altitude: less oxygen with high altitude= increased RR
• Males have larger lung capacity=lower RR
• Posture: slumped or stooped= more difficult to exchange o2
What is temperature?
A measure of heat associated with metabolism in the body
Normal temperature
Abnormal temperature
‣ Pyrexia (fever)
• Etilogy:
◦ infection
◦ Neurological disease
◦ Malignancy
◦ Congestive heart failure
◦ Trauma
◦ Drugs
• Delirium or convulsions may happen with high fever
‣ Hypothermia (below 95 F)
• Etilogy:
◦ medications
◦ Malnutrition
◦ Illness
◦ Trauma
ASA classification
ASA Classification
Origin: American Society of Anesthesiologists created system in 1941
Purpose: assess patient’s health and risk for complications before surgery and after anesthesia
Dental clinicians also uses this classification to assess patient’s level of health and their risk for complications/ medical emergencies
ASA 1 and 2 safe to treat in practice with none or minimal modifications to tx
ASA 3 and 4 higher risk for med emergencies so will require substantial modifications in their management and tx; may need referral to hospital setting. Elective tx shouldn’t be done on an ASA 4
All ASA classifications
ASA 1
• Normal healthy patient, no psychiatric, organic and physiologic disturbances
ASA 2
Mild systemic disease or risk for systemic disease
• Tobacco smoker without COPD
• Obese
• Pregnant
• Infant
• Well controlled mild disease
• Type 2 diabetes without systemic effect
Social drinker
ASA 3
• Severe systemic disease that causes limitations
• Controlled severe systemic disease
• Multiplied well controlled systemic diseases (more than one body system)
• Well controlled type 1 diabetes
• Controlled heart failure
• Stable angina
• Poorly controlled HTN
• Morbid obesity
• Chronic renal failure
• MI greater than 6 months without residual signs or symptoms
• Poorly controlled asthma
• No immediate danger of death
ASA 4
• Severe systemic disease that is a constant threat to life
• May have shortness of breath or distress at rest
• MI within last 6 months
• Unstable angina
• Symptomatic heart failure
• COPD
• Hepatorenal failure
